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I’m still on vacation (we all know how important work-life-balance is!), so this week another awesome colleague of mine, Hanne Watkins from the University of Melbourne, is filling in and reflecting on role models and conflicting goals in the male-dominated world of academia.

I had gotten pretty far in my academic career – all the way to Honours – before I had a female role model. The fact surprised me then, and troubles me now. Had I really gone through all of High School and undergrad without having a female professional to look up to?

It is also possible, however, that I did have female role models before that, but that I hadn’t realised they were female. It sounds silly when I put it like that, but I think I can explain. Prior to my Honours year, I might have had role models – teachers, writers, researchers, politicians – who I looked up to as figureheads in their respective professional and public domains, but where their gender (and mine) was irrelevant to their position as “my role model”.

But regardless. In Honours, the gender of my role model was suddenly relevant. She (let’s call her K) was a lecturer at my uni; she was smart and friendly and gave me career advice. These are all (arguably) gender-neutral activities, so I don’t want to overstate the centrality of the gender aspect of her role. Gender became salient to me, however, for two reasons. First, because K herself often talked about gender, feminism, and academia. Second, because she was over forty, single, and childless.

Going by cultural stereotypes, “forty, single, and childless” sounds like a woman’s nightmare. But K wasn’t living a nightmare. She was happy, she was an academic, she was smart and friendly and gave me career advice – and I wanted to be like her. Prior to meeting K, I had on some (mostly unconscious) level assumed that children would inevitably enter the picture at some point in my future. She freed me from that illusion, by showing me an alternative reality; a reality I wanted for myself as well, and which, thanks to her, looked achievable! Maybe it doesn’t sound like much, but at the time it was something of a revelation.

I’m not overly familiar with research on role models. But, I believe one theory suggests that for role models to “work”, you first have to have a desired goal, then you have to see someone who has achieved that goal, and then you have to perceive a “fit” between yourself and that person. (And some of the causal arrows probably go in both directions.) K ticked all the boxes. I wanted to be a childless academic in the future, K was that person now, and I was like K in that we were both female. (And, you know, smart and friendly and fond of dispensing advice. 😉 )

For a while, things were going along swimmingly.

Then, something dramatic happened: I started to want to have kids.

By that stage I had met lots of other amazing female academics, some of them older than me, some of them not; some of them with kids, some of them without. So you’d think I could find a role model among them, right?

Unfortunately, it hasn’t been that simple (surprise surprise). Thinking about the research on role models, however, has made me ponder how my predicament can be understood through the theory of role models I described above.

I have two desired goals: have children, and be an academic. I’m not willing to give up either goal, which means my combined goal is to be an academic who has children. As I said above, I have met plenty of women (and men!) who have achieved that goal. However, I wouldn’t describe any of them as my role model for this combined goal. Instead, it’s as if my goals obstinately generate their own, separate, role models.

On the one hand, I aspire to be like some awesome academics I know; whether they have children or not seems irrelevant. With some of them, I perceive a fit – they are “like me” in some ways, and so they are the ones I would call my role models, and they are the ones who inspire and motivate me.

On the other hand, I aspire to be like some awesome mothers I know; what else they do seems irrelevant. Unfortunately, with none of these do I perceive a fit – because none of them are academics. This makes me feel as if my goal of being a mother is incompatible with being an academic, even if, as I said above, I know this isn’t true.

So. In some ways, what I have just written is just another version of the “oh no I have conflicting goals and I will have to find a way to compromise”-dilemma. So I’m sorry that it’s old news.

However, I think the new news, to me at least, is that the theory of role models can help me understand why these goals of mine seem to conflict at such a deep level.

Sometimes, the parenting-working conflict seems to be portrayed as a matter of time-management, organisation, and communication – certainly challenging, but relatively “superficial” things. Seeing the conflict as one between competing role models, however, suggests that it’s not just a about what I might want to do to achieve my goals. It is about who I want to be.

As I am currently on vacation, my lovely colleague Helena Radke from the University of Queensland has agreed to step in and provide this week’s post. Thanks a lot, Helena, and to the rest of you: enjoy.

There are many reasons why women might not feel comfortable speaking up about gender discrimination in the workplace. One reason why women might not want to attribute an outcome to discrimination is because they experience disapproval from others when doing so. Regrettably this apprehension is not unsubstantiated. Social psychological research conducted by Kaiser and Miller (2001) has found that a person who attributes their treatment to discrimination (in this case an African American student failing a test) is evaluated more negatively than someone who does not attribute their treatment to discrimination even when it is clear that the person is being discriminated against. This is why, while many women say that they would confront sexism when presented with a hypothetical scenarios of discrimination, they are actually much less likely to do so in real life (Swim & Hyers, 1999).

So how can we ensure that women feel comfortable speaking up about instances of discrimination? One way in which we can answer this questions is by considering gender discrimination in the workplace to be a microaggression. According to Professor Derald Wing Sue from Columbia University, microaggressions are a brief and commonplace instances of indignity which, either intentionally or unintentionally, communicate hostile slights towards another person because of the social groups they belong to (Sue, 2007). He argues that they can be overcome by being aware of our own biases, knowing that our reality is different to others reality, not being defensive when someone reveals an incident of discrimination, discussing our own biases and being an ally against discrimination (see this video). Creating an organisational climate which is aware of the microaggressions women experience could be one way in which we can overcome the barriers women face to confronting gender discrimination in the workplace.

This week, we have once again a guest post. This time, it’s by the awesome KBW, whose blog I can highly recommend. Also, we love guest posts, so if you are interested in writing one, please get in touch!

Much as changed in the near 20 years I have been in and around the medical profession and the progressive feminisation has been wonderful to see and be part of.

There are many women in surgery, far more now than when I was a medical student and I don’t think there is any real problem with being a woman in surgery. Some of the women in surgery I encountered early in my career had children and husbands but very few of them were living a life I aspired to. In fact, if anything they put me off and some made me feel even less welcome than the boys. I don’t know if you’ve ever seen the movie Legally Blonde, imagine that but everyone in white coats; times have changed though and we have a gradual spread of women throughout surgery, not all of whom are doing it like the men did.

I have to acknowledge my parents input, who have an unshakeable belief (which they passed on to me) that I can do anything that I want to do. I was never expected to be slower, weaker or less at anything compared to my brothers and male cousins so not doing general surgery because I was a girl never crossed my mind.

It was on everyone else’s mind though, when I first started popping up in theatre as a super keen student and junior house officer the animosity from some middle grade doctors and the theatre nurses was incredible, I was never expected to actually, really be a surgeon. Also, some well meaning consultants would gently suggest that maybe I would change my mind about general surgery once I had a husband and children and would I really want to work weekends and night shifts forever? Maybe I would think about doing general practice?

We now have hordes of female medical students and junior doctors all wanting to do surgery, most of whom want to come and spend some time hanging about with me. I am aware that as the part time mummy surgeon in great shoes I have a responsibility as a role model to them. When I was a medical student I would have run a mile from the likes of me, but this lot are sent to me by my colleagues to get “the talk”. Three things about this situation bother me, which I no doubt contribute to by seeming approachable.

Firstly, they seem to think that my personal life and circumstances are something that they can ask all about. How do I organise my childcare? Have I encountered any discrimination problems? How do I manage to get up and dressed and organise things and get there for 0745? How much maternity leave did I take? Do I ever feel guilty about leaving my children and not making it home for bedtime? So far nobody has asked me if I had vaginal deliveries but they have gotten close.

I don’t mind this when it is a doctor I actually know, someone who is considering embarking on a career as a surgeon but I do mind having to tell every student that comes through the department about how my kids are looked after and whether or not I have a cleaning lady (I do, twice a week in fact, so I can get to the gym on my days off and not spend the time ironing) or if I do the cooking at home. They also want to know what Mr KBW does and how we make our marriage work with our busy schedules. This seems totally irrelevant to being a surgeon and more to do with being a mummy and a wife, it amazes me that these young girls are thinking about their 35 year old selves, I certainly never did.

The other thing that bothers me is that some are entirely focused on being discriminated against because they are a woman. This has not been my experience at all, there have been very few people (one particularly rude man who is responsible for most of the bile duct injuries within 100 miles of Bighospital) who have openly discriminated against me.

The only real problem I’ve had because I am a woman is getting elbowed in the chest during laparoscopic surgery all the time and trying to accommodate my enormous 38 weeks pregnant abdomen at the table during laparotomies. Not that I think being female has made it easier, even if my colleagues (and so called friends) said my viva exams were dumbed down because I was the pretty girl. Maybe they were, but I knew the answers to the harder stuff as well so bollocks to them.

Finally, not one single boy has ever especially come to me or been sent to me to discuss a career as a surgeon, perhaps they get sent to the men.

So what do I tell these girls in “The Talk”?

I admit there is the endless everyday sexism that all women encounter but I suspect it is not any different for women in law, the police, schools and offices. They see this on the ward round, in clinic, with my bosses and there is no point ignoring it. For example, I won a prize last month and was quite pleased about it “well done” said my boss “a lot of guys on the panel?” as he gave me a “friendly” tug on my pony tail, ho ho. This is everyday sexism, as are the patients who reply “all the better for seeing you sweetheart” when I do my rounds and enquire how they are; it used to flummox me or make me angry or embarrass me.

This isn’t discrimination based on gender, but it is sexist behaviour. It could be demeaning if I let it demean me. So I tell the students that they will experience very little discrimination but occasional sexism but it probably isn’t any worse than in any other job.

I tell them that they have to love surgery because it will take them away from people they love. They have to love it like a crazy obsessed stalker lady. First days at school, Christmas Day, nativity plays, family birthdays, your wedding anniversary…the list of days you won’t and can’t be there is endless. If you don’t love your job you will resent the time you spend there when you feel you should be somewhere else and that makes you a bad doctor. The hours at the computer writing papers, the long trips travelling cheaply to conferences alone, the late nights etc.

Surgery is like a boyfriend who constantly makes you prove how much you love him and plays games with your feelings. The semi mandatory research PhD and MD degrees are like getting a tattoo of his name and just when you think he loves you, and you and he are getting on so well he will punch you in the face with a complication that makes you buckle at the knees.

I also tell them to speak to people about it and urge them to get feedback on their hands and technical skills. Not everyone can do surgery and the sooner you realise that you have hands suited for a career as an occupational health physician the better. I also try and discourage them from being rigidly attached to a specialty very early. Better to want to be a surgeon and consider all the surgical specialties early on than having your heart set on being a head and neck cancer surgeon from the age of 19.

Again, to use the boyfriend analogy, not many people who are determined to find and marry a blonde 6 foot welsh rugby player, 2 years older than them, with no baggage, minimal chest hair, nice feet and works as a vet in the country end up doing so (trust me on this one, I know the woman who wanted this and she is 38, lonely and miserable). So keep your options open and consider all types of surgery.

It also helps to have role models and mentors to guide and influence you. They don’t need to be told that they are your role model, there is no need to formalise the process. Mine have been almost entirely male, there have been about four that have massively influenced my professional and personal life for either a brief period (an amazing plastic surgeon who wrote plays and was an amateur actor) or the few that have been around for most of my adult life (the great leaders).

What most of mine have in common is a rich and varied life out with medicine; all are excellent surgeons and lead their teams well, they are well liked and respected and are exceptionally nice and clever people. These characteristics are not gender specific, as a group they probably are slightly more effusive than other male surgeons but they are all white, British, quintessential Royal College material men. There are of course a few women that have influenced me, one in particular that is about 5 years ahead of me has taught me a lot more than just how to operate and it has been interesting to watch her go from stage to stage and see the few mistakes she has made and the many things she has done right and continues to refine.

Find people you want to be like and ask them how they got there. That might be the workaholic, hugely productive university professor who spends every second at work and publishes endlessly. It might be the guy in the super flash suit whose patients love him and he works tirelessly for them. It might be the forgetful, kind hearted amazing surgeon who can teach almost anyone to do anything.

Above all else, realise that this is a journey where there is no final destination. You will always be learning, always trying to get better, always be teaching others and trying to get better at teaching others.

There is nothing I would rather do than my job, it is the greatest privilege and the most amazing challenge and it is super fun and makes me happy. Not many people can say that about their work, so find a role model that smiles on the way into the hospital and looks happy in theatre because that’s how you should want to feel too.

If you are interested in guest blogging on this site some time, please get in touch. It would be great to make guest blogs a somewhat regular thing! But now, without further ado, here is what Tiffany has to say:

When I was accepted into plastic surgery training back in my mid-20’s, I was the only female plastic surgery trainee in the state. There was only one female plastic surgeon working in town, but she was trained overseas and imported into our hospital. She was my mentor and ally. She told me stories of her training and gave me valuable insight into the minds of my male colleagues.

When I first started training, I used to get upset about every little thing. She used to shake her head at me and said that I should toughen up, use my stiff upper lip, and basically grow a tough hide. But it wasn’t until she said to me ‘Take it like a Man’ that I realised to succeed and survive my training, I needed to be like my male colleagues. I needed to be one of them.

Behaviour

Short of wearing pants and ties, I started to observe my colleagues. They don’t cry when they get upset (well, maybe only when they were very very drunk), and they tell you as it is when they are. However, when I started to behave like one of the boys, people’s response to me was completely different. When one of my male colleagues started to rant and rave about something that had not been done for his patients, deathly silence ensued, and the nurses scrambled to do his bidding. When I mention that a certain instruction was not followed, nurses shrugged their shoulders at me and I was called a bitch behind my back.

Once, I watched one of my colleagues brush off a female patient’s concern as if it didn’t really matter. The patient reacted by shrugging her shoulders and put it down to ‘he’s a man, he doesn’t understand.’ Yet when I inferred a similar response to her complaint, she carried on about how that I was an unsympathetic doctor and should have been more understanding of her feelings.

So I learnt my lesson. I had to be tough like a male, but I needed to behave like a female, because my co-workers and my patients expected me, as a woman, to be more perceptive to their feeling, to be gentler, thoughtful, considerate and compassionate. All the qualities of their mothers.

Competency

And yet what did people expect of my abilities as a female?

There are several facets to this issue. Firstly, people make assumptions that you understand certain aspects of their lives, or have specific skills because you are female. Patients often tell me that they have specifically chosen me as their surgeon because I am female. That they know I will pay more attention to detail, that my work would be more delicate and that I have gentler hands. I have found these ideas vocalised more from female patients, although the back-handed sexist compliment makes an appearance now and then from the male patients: ‘Female hands are made to do fine embroidery, your sewing would be better.’ This is all inference without evidence. Some of the best microsurgeons I have had the privilege of learning from, are male surgeons with big clumsy-looking hands who couldn’t sew a hem to save their lives.

Some tell me that I would better understand what results they are after because I am female. One of my specialties is cosmetic and reconstructive breast surgery. Even my colleagues have presumptions and send their wives to me as a preference because I would know what beautiful breasts are supposed look like. I have my suspicious that it was more because they hesitate to have one of their male colleagues handling their wives’ bosoms. I often joked with them that beauty is in the eye of the beholder, and unless their wives are lesbians, what I thought would not really matter. Not to mention, as far as I was concerned, you are too big if you are bigger than me. Without fail, their gaze would lower to the A cup push-ups I wore hidden under my dress. The disappointment in their eyes when they come back up to my face is almost comical.

An interesting social survey that was done locally in my state by the Plastic Surgeons’ Society showed that majority of women preferred a male plastic surgeon for cosmetic procedures, but female plastic surgeons for reconstructive procedures (e.g. after cancer surgery, or for treatment of congenital deformities). I guess this may just be a reflection of the underlying reasons for these procedures. Most of the patients who have cosmetic procedures book in because they want to look attractive for the opposite sex, whilst those who have reconstructive procedures proceed for their own self-esteem.

But realistically, are male surgeons better than female surgeons? My personal experience is that overall, the common public perception is that male surgeons are more competent. It is not that unusual for my patients to ask for a second opinion specified to be from a male surgeon. It is also not uncommon that patient find it easier to accept an opinion (especially one that they do not agree with) from a male surgeon. Sometimes I would argue patients until I am blue in the face about my decision, and yet when my male colleague comes to the same conclusion, the answer is a meek ‘Yes, whatever you think is best, doctor.’ It is also not uncommon that when I am doing ward rounds with my junior male residents, the patients look to them to reassurance, assuming that they are the doctors in charge.

This perception is not just restricted to patients. I have had male colleagues who have volunteered to take difficult cases from me because they felt that it was stress I didn’t need or the procedure would be too long for me. I have had to stop myself being a ‘hypersensitive girl’ and ask them if they were questioning my competency; instead, I would often smile sweetly and tell them that ‘you are so thoughtful, but I really enjoy the challenge’. There is also no doubt that my male colleagues are particularly protective of me at times. Once I was bullied by a male colleague from another specialty, because he was not willing to accept that he made a mistake with my patient, an incident which I unfortunately had to bring up at the morbidity and mortality (M&M) meeting. The next thing I knew, two male surgeons from my department cornered the poor man in the tea room two days later. Ever since the incident, that particular surgeon seemed to be awfully fond of stairs when we bump into each other at the hospital lifts. The male protectiveness didn’t just come from senior staff either. When I have had to visit the secure unit (prison hospital) to see some patients with my junior residents, I have had male residents trying to protect me from seeing obnoxious abusive patients. Sweet, but totally unnecessary. I was more effective in getting the prisoners to comply with their therapy than any other surgeon. Apparently a pissed off female surgeon is a lot more terrifying than a male one.

Confidence & Self-Esteem

So with such behaviour surrounding female surgeons, you would think we have no confidence or self-esteem in ourselves. Yes and No. I believe these are two very different things.

Confidence is a projection, or a façade as I’d like to think. This is something a lot of female surgeon learn very quickly early on in their career, because a show of weakness or doubt, especially in front of our male colleagues or senior staff, was a sign we didn’t have what it took to be a good surgeon. Being decisive and making good clinical judgement is the crux of a good surgeon. Several times throughout my career it was emphasised to me that you could teach a monkey to operate, but you could never teach it to choose the right operation. Personally, I don’t think it is hard to project the illusion of confidence, because you see it around you constantly from all your colleagues. I don’t need to puff up my chest or spit at my feet, but when I announce my decision to the team, it is clear to all and sundry that it was my way or the highway.

Self-esteem, however, is another matter. It is no secret that females are more introspective than males. Looking at the gender difference in the psychology of cause and reason – females tend to blame themselves, and males tend to blame external factors. This is no different in surgery. How many times during an M&M have I had to listen to my male colleagues go on and on about how the surgical instruments they were using were old and unreliable, about how the patients were non-compliant, about how the disease was so advanced or that the patient’s anatomy was abnormal. Whereas I hear female surgeons lament about how they should have done this, thought about that, or even not have taken on the challenge in the first place. Whenever an unexpected problem occurs, the female will look inside themselves for reasons rather than recognise that sometimes the patient’s pathology defeats even the best surgeons.

This is something I constantly remind my female trainees (and myself from time to time). I tell them that there has never been any evidence that female surgeons are less competent than male surgeons. Yet, we have an innate inferior complex about ourselves. We tend to beat ourselves up when things go wrong. Then we are tempted to fall in a heap of self-pitying mess. I often tell them that we can’t ignore this female psyche we possess, if anything, it makes us a better surgeon because we are constantly evaluating ourselves. But we have to have the insight to understand that too much of it can be debilitating. Good surgeons should be able to move on from their complications, ‘failures’, and mistakes – to learn from it, and start the next case as a completely fresh problem. We shouldn’t be accumulating ‘baggage’ which erode our self-esteem, because our patients rely on us making the right decisions for them at every crucial moment – and the right decisions are never made when self-doubt takes over the decision making process.

Confidence and self-esteem does go hand in hand. The more self-esteem one possesses, the easier it is to project confidence. However, the biggest trick in the trade is to be able to take criticisms, scrutinies, mistakes and failures on the chin, and yet still project the same confidence so that both your colleagues and your patients will continue to have faith in your abilities. If being a female means you are more critical of yourself, this is not necessarily a bad thing, it just need to be moderated. Having good support from a sympathetic colleagues (male or female) can also go a long way.

Even though surgery is slowly being ‘infiltrated’(as one of my male colleagues like to put it), by females, it is still very much a male-dominant area of medicine; partly due to diminishing remnants of the ‘Old-boys’club’ attitude, but mostly due to its unrelenting hours and commitment. A career in surgery is unconducive for the stereotypical role of women – one of bearing babies, spending time with family, home making and baking cookies. Honestly, the only babies I see are those in the hospital, and the only baking I do is with a diathermy.

So until we have more female surgeons, and society start to see us as the norm, my belief is that we should Take it like a Man, but Give it like a Woman.